Do emergency department patients with possible acute coronary syndrome have better outcomes when admitted to cardiology versus other services?

David A Katz; Tom P Aufderheide; Mark Bogner; Peter S Rahko; Stephen L Hillis; Harry P Selker

doi:10.1016/j.annemergmed.2007.05.016

Back

Do emergency department patients with possible acute coronary syndrome have better outcomes when admitted to cardiology versus other services?

Journal article

Peer reviewed

Do emergency department patients with possible acute coronary syndrome have better outcomes when admitted to cardiology versus other services?

David A Katz, Tom P Aufderheide, Mark Bogner, Peter S Rahko, Stephen L Hillis and Harry P Selker

Annals of emergency medicine, Vol.51(5), pp.561-570.e1

05/2008

DOI: 10.1016/j.annemergmed.2007.05.016

PMCID: PMC7710008

PMID: 17764781

View Online

Abstract

Emergency physicians need to consider potential differences in quality of care across admitting services in their triage decisions. For emergency department (ED) patients with possible acute coronary syndrome who require hospitalization, there are relatively few data to guide emergency physicians in deciding whether admission to a cardiology service bed yields better outcomes than admission to a noncardiology service. We enrolled 544 ED patients who were admitted for symptoms of possible acute coronary syndrome after a nondiagnostic initial evaluation during a quality improvement trial at 2 university hospitals. Adverse events, inhospital treatment, and follow-up care were assessed by 30-day telephone interview and medical record review. We used a modified version of the Medical Outcomes Study Short Form 20 and the Duke Activity Status Index to assess functional status. To account for selection bias, we analyzed process and outcome variables after adjustment for the estimated propensity of being admitted to cardiology and predicted probability of acute cardiac ischemia. Overall, 34% of admitted patients had confirmed acute coronary syndrome. Patients admitted to a cardiology service were significantly more likely to undergo evaluation for ischemic heart disease than those admitted to a noncardiology service (adjusted odds ratio for noninvasive testing 2.7; 95% confidence interval 1.7 to 4.2) but were not more likely to receive recommended therapies. The incidence of ED revisits and rehospitalizations, functional status, and adverse cardiovascular events were similar in both groups. ED patients admitted for evaluation of possible acute coronary syndrome do not experience worsened short-term outcomes if admitted to a noncardiology service bed.

Outcome Assessment (Health Care) - methods

Quality-Adjusted Life Years

Humans

Middle Aged

Medical Records

Acute Coronary Syndrome - physiopathology

Male

Emergency Service, Hospital - statistics & numerical data

Cardiology Service, Hospital - statistics & numerical data

Acute Coronary Syndrome - diagnosis

Electrocardiography

Acute Coronary Syndrome - therapy

Female

Interviews as Topic

Wisconsin

Details

Title: Subtitle: Do emergency department patients with possible acute coronary syndrome have better outcomes when admitted to cardiology versus other services?
Creators: David A Katz - Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA. david-katz@uiowa.edu
Tom P Aufderheide
Mark Bogner
Peter S Rahko
Stephen L Hillis
Harry P Selker
Resource Type: Journal article
Publication Details: Annals of emergency medicine, Vol.51(5), pp.561-570.e1
DOI: 10.1016/j.annemergmed.2007.05.016
PMID: 17764781
PMCID: PMC7710008
NLM abbreviation: Ann Emerg Med
ISSN: 0196-0644
eISSN: 1097-6760
Grant note: R01 HS10466 / AHRQ HHS K23 NS002163 / NINDS NIH HHS
Language: English
Date published: 05/2008
Academic Unit: Radiology; Epidemiology; Biostatistics; General Internal Medicine; Internal Medicine
Record Identifier: 9984094513802771

Metrics

23 Record Views

8 Times Cited - Web of Science